Image Credit: Pixabay, user name: geralt
Over the past week, the global pandemic of Coronavirus (COVID-19) has continued to have a significant impact on people’s health, but also on every aspect of life. Business, employment, healthcare and education are just a few areas shouldering a large burden. Each day, the pandemic has continued to worsen, with the number of new infections and deaths increasing across a wider number of geographies as well as deepen within larger western economies, particularly Europe and America. The global number of new infections has started to grow by >50,000 per day and new deaths by >3,000. These are tragic milestones and difficult numbers to process in terms of the loss of life.
At the same time, there is still hope that transmission can be interrupted and lives saved by the actions taken by governments and their healthcare systems. Wuhan is a good example of this. It was originally at the centre of the pandemic, although due to the actions taken by Government, the province continues to report no new organic cases of COVID-19. In addition, there are over 100,000 people globally who have reportedly recovered from the virus, in part, thanks to the hard work from frontline healthcare workers as well as their governments mobilising resources to support healthcare systems.
Below is a summary of some key developments and information published by the WHO this week.
Firstly, starting with the latest numbers. During Thursday 26th March, the global number of reported COVID-19 cases surpassed 500k. During the proceeding 48 hours, they surpassed 600k. As of 10:00am (CET) 29th March, China has 82,356 reported cases in a population of 1.4 billion people. In the rest of the world, there are 552,479 reported cases, in a population of 6.3 billion. This has resulted in a total of 29,957 deaths or 4.7% of the reported case count. Europe continues to be the epicentre of the pandemic as the region has reported more cases and deaths than the rest of the world combined. That said, the numbers from America have begun to accelerate and are now worse than China in terms of the overall number of infections.
The global mortality rate is trending upward and the WHO is reporting large differences in the mortality rate between regions. During the press briefing on Friday 20th March, WHO Scientific-Technical Lead Dr Maria van Kerkhove shared some comments on this. She noted that there is a combination of factors around why we are seeing differences in mortality amongst regions and that we have to be very careful about making comparisons at this point. The primary reason behind these differences appears to be due to the population demographics that the virus is affecting and infecting. For example, we may expect a higher mortality rate from older and ageing populations. That said, the number of deaths over the number of cases is only a snapshot and we don’t know the extent of infection within the population, therefore, this is an incomplete snapshot. There are also many people still in a severe condition, some of whom will recover and some of whom will die, therefore we don’t have precise numbers yet. The optimistic scenario is that the number of infections are under-reported and therefore the mortality rate is much lower than the numbers suggest.
The WHO reiterates that COVID-19 is capable of causing infection and severe disease in people of all ages. The initial characteristic of the virus has been that it impacts those of older age. While this is somewhat true, the WHO is calling for more well-characterised descriptions of severity across age groups so that better analysis can be conducted. Within younger age groups, the data suggest that the majority of children that are infected are experiencing mild disease, but we do have reports that some children are experiencing severe disease and even death. The number of deaths in children is still very low although this highlights that COVID-19 can be severe across all age groups.
The number of true asymptomatic cases is very low. Many patients labelled as asymptotic are actually be pre-symptomatic. During the press briefing on Friday 27th March, WHO Scientific-Technical Lead Dr Maria van Kerkhove commented that “we need to be very careful in our language here. The use of the word asymptomatic globally is, I think, not appropriate” and “most people who are identified as asymptomatic were identified as part of contact-tracing. That means they’re already being medically followed and therefore they’re being tested early. Many of those individuals who are listed as asymptomatic are indeed pre-symptomatic and they go on to develop symptoms a day or two later.” Understanding the epidemiology and the drivers of transmission is a priority for the WHO. Their data indicates that the drivers of transmission are people who are symptomatic which includes people who are in the very early stages of symptoms. It is from the people who are feeling “just a little bit unwell” who are the ones that are driving the transmission.
The COVID-19 Solidarity Fund, launched two weeks ago, has now received donations of more than US$108 million from 203,000 individuals and organisations. The fund was established to raise money to support the activities of the WHO and it’s partners in order to respond to COVID-19.
Clinical trials are in progress for a vaccine although Dr Tedros indicated that a successful vaccine is still at least 12 to 18 months away. One of the R&D activities led by the WHO is the Solidarity Trial announced on Friday. Patients are being enrolled in order to compare the safety and effectiveness of four different drugs or drug combinations against COVID-19. This is a historic trial which will dramatically cut the time needed to generate robust evidence about what drugs work. More than 45 countries are contributing to the trial, and more have expressed interest.
The WHO urgently urges individuals and countries to refrain from using therapeutics that have not been demonstrated to be effective in the treatment of COVID-19. The history of medicine is strewn with examples of drugs that worked on paper, or in a test tube, but didn’t work in humans or were actually harmful. During the most recent Ebola epidemic, for example, some medicines that were thought to be effective were found not to be as effective as other medicines when they were compared during a clinical trial. The WHO urges the global community that we must follow the evidence.
The United Nations launched a US$2 billion COVID-19 Global Humanitarian Response Plan to support the world’s most vulnerable countries. Press release.
When health workers are at risk, we’re all at risk. The chronic global shortage of personal protective equipment (PPE) is now one of the most urgent threats to our collective ability to save lives. The current market dynamics have been creating extreme difficulties in ensuring health workers have access to the equipment they need to do their jobs safely and effectively. WHO has shipped almost 2 million individual items of protective gear to 74 countries that need it most, and they are preparing to send a similar amount to a further 60 countries. But much more is needed. This problem can only be solved with international cooperation and international solidarity.